Link: http://www.plospathogens.org/article/info%3Adoi%2F10.1371%2Fjournal.ppat.1002079

Excerpt:

Using a yeast surface display approach, 
a tick gut protein named TRE31 was identified to interact with BBE31. 
Silencing tre31 also decreased the B. burgdorferi burden in the tick 
hemolymph. Delineating the specific spirochete and arthropod ligands 
required for B. burgdorferi movement in the tick may lead to new 
strategies to interrupt the life cycle of the Lyme disease agent.

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

*********It is time that patient’s start standing up and pushing back….sitting back and doing nothing is getting us no where.

*********We need to stop “fearing” city hall, when we can be city hall in these Lyme wars.

*********Just remember folks, Lyme isn’t just carried by ticks….look to birds, rodents, mice, we need to understand that it is up to us Lymie’s to take a stand.

Regards,

Linda

Article Excerpt:

New Haven, Conn. – The range of Lyme disease is spreading in North America and it appears that birds play a significant role by transporting the Lyme disease bacterium over long distances, a new study by the Yale School of Public Health has found. The study appears online in the journal Frontiers in Ecology and the Environment.

Researchers analyzed published records and concluded that at least 70 species of North American birds are susceptible to infection by black-legged ticks (Ixodes scapularis), the principal vector of the Lyme disease bacterium (Borrelia burgdorferi). The evidence also suggests that these bird species are dispersing infected ticks into areas that had previously been free of the disease, such as Canada.

Lyme disease bacterium is usually associated with small mammals such as mice and squirrels. Immature ticks (in the larval and nymphal stages) become infected with the bacterium when they feed on these mammals. During subsequent blood meals, an infected tick transmits the infection to other hosts, including humans. White-tailed deer-while playing an important role in maintaining and spreading tick populations-are a biological dead end for the bacterium because its blood is immune to infection.

Birds, however, are not immune and numerous species get infected and are capable of transmitting the pathogen onto ticks, the researchers found. What remains to be seen is whether the B. burgdorferi strains that can infect birds can also cause disease in humans. If so, the role of birds in the epidemiology of Lyme disease could be profound.
 

To read the whole article:

http://www.healthnewsdigest.com/cgi-bin/artman/search.cgi

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

“Children are more likely to present with arthritis as initial manifestation of Lyme disease,” Dr. Cruz told the audience.

“Children with Lyme arthritis presenting with a limp and a swollen joint will typically have a lower peripheral white blood cell count,” Dr. Cruz added. “They are less likely to have complete non-weight-bearing on the affected limb, less likely to have a fever, and [arthritis symptoms are] more likely to involve the knee joint compared with children with septic arthritis.”

The findings were reported here at the American Academy of Pediatrics 2009 National Conference & Exhibition.

Basic Diagnostic Tools Help Distinguish Lyme From Septic Arthritis

“In the Northeast, we see a lot of Lyme disease,” said Yi-Meng Yen, MD, PhD, instructor in orthopaedic surgery, Harvard Medical School, Children’s Hospital Boston in Massachusetts. “It is hard to distinguish whether [it] is Lyme disease or whether [it] is septic arthritis,” Dr. Yen agreed.

“Septic arthritis mandates that we take the patient to the operating room and do a surgery, whereas Lyme arthritis theoretically can be treated with antibiotics,” he told Medscape Pediatrics in an interview. For instance, he said, “Our institution has been looking at MRIs [magnetic resonance images] as a way to reliably distinguish between the two, because it takes several days sometimes for the lab tests to come back to definitely tell you whether you have Lyme disease or not. So, in those few days, if you have septic arthritis, that’s a bad thing.”

“To reliably, quickly diagnose what the patient has can help us determine the treatment quickly,” added Dr. Yen, who was not involved in this study.

“If you are clinically susceptible for septic arthritis, it pays to go to the operating room,” Dr. Cruz said in answer to a question from the audience. “In the past, almost all these patients automatically went to the operating room.”

However, if the clinical presentation is consistent with Lyme arthritis, treatment with antibiotics should suffice, he added. “The point of this study was to come up with some clinically useful criteria to arm ourselves with more tools to diagnose the disease.”

Dr. Cruz and his team sought to evaluate clinical parameters that could eventually be used to differentiate Lyme arthritis from septic arthritis in children and help with diagnosis and subsequent treatment.

In this retrospective analysis, the investigators reviewed data from children who underwent lower-extremity joint aspiration at Yale University Medical Center, a tertiary care children’s hospital in a Lyme disease endemic area.

Between August 2002 and August 2008, more than 200 children underwent a total of 212 aspirations for a joint effusion. Cell count, culture, hematologic inflammatory markers, and subsequent surgical intervention were available for 170 of the 212 aspirates.

Dr. Cruz’s team compared findings from 50 children with serologically confirmed Lyme disease with data from 21 patients with culture-positive septic arthritis.

They found statistically significant differences between the 2 cohorts. For instance, the peripheral white blood cell count was 9.5 x 1000/μL (range, 3.0 – 14.9 x 1000/μL) in the aspirates from children with Lyme disease vs 12.5 (range, 5.5 – 30.1) in children with septic arthritis (P = .002).

Other parameters, such as joint fluid cell count, erythrocyte sedimentation rate, and C-reactive protein levels, were not significantly different between the 2 groups and could not be used to differentiate between septic and Lyme arthritis.

Interestingly, said Dr. Cruz, of all the children presenting with a joint effusion at their hospital, 29% were likely to be diagnosed as having Lyme arthritis overall compared with 44% if the aspirate was a knee aspirate.

“Is it worthwhile to develop something that’s very reliable? Absolutely!” said Dr. Yen. “Especially in the Northeast centers. It is a growing healthcare problem and a lot more study should be put into it.”

Dr. Cruz and Dr. Yen have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition (NCE): Abstract 5806. Presented October 17, 2009.

Journalist

Crina Frincu-Mallos, PhD

Crina Frincu-Mallos is a freelance writer for Medscape Medical News.

• American Academy of Pediatrics (AAP) 2009 National Conference and Exhibition

This coverage is not sanctioned by, nor a part of, the American Academy of Pediatrics.

From Medscape Medical New

New Haven, Conn. — A protein found in the saliva of ticks helps protect mice from developing Lyme disease, Yale researchers have discovered. The findings, published in the November 19 issue of Cell Host & Microbe, may spur development of a new vaccine against infection from Lyme disease, which is spread through tick bites.

Traditionally, vaccines have directly targeted specific pathogens. This is the first time that antibodies against a protein in the saliva of a pathogen’s transmitting agent (in this case, the tick) has been shown to confer immunity when administered protectively as a vaccine.

The Lyme bacterium known as Borrelia burgdorferi is transmitted by ticks. When it moves through the tick, it is coated with a tick salivary protein known as Salp15. The Yale team injected Salp15 into healthy mice and found that it significantly protected them from getting Lyme disease. When combined with outer surface proteins of B. burgdorferi, the protection was even greater.

Lead author Erol Fikrig, M.D. of Yale School of Medicine and Howard Hughes Medical Institute said, “The interaction between the Lyme disease agent and ticks is very complex, and the bacteria uses a tick salivary protein to facilitate infection of the mammalian host. By interfering with this important interaction, we can influence infection by the Lyme disease agent.”

Several years ago there was a Lyme vaccine on the market that utilized just the outer surface proteins of the bacteria. It was taken off the market in 2002, and to date no other antigen has been tested in phase III clinical trials.

The authors believe this new strategy of targeting the saliva – the “vector molecule” that a microbe requires to infect a host – may be applicable not just to Lyme disease but to other insect-borne pathogens that also cause human illness.

“We believe that it is likely that many arthropod-borne infection agents of medical importance use vector proteins as they move to the mammalian host,” Fikrig explained. “If so, then this paradigm, described with the Lyme disease agent, is likely to be applicable to these illnesses. Currently, we are working to determine if this strategy is likely to be important for West Nile virus infection, dengue fever, and malaria, among other diseases.”

Other researchers were Jianfeng Dai, Penghua Wang, Sarojini Adusumilli, Carmen J. Booth and Sukanya Narasimhan of Yale School of Medicine, and Juan Anguita of the University of Massachusetts. This work was support by grants from the National Institutes of Health.

 http://opa.yale.edu/news/article.aspx?id=7083
 
FOUND IN: Health & Medicine

PRESS CONTACT: Helen Dodson 203-436-3984

November 13, 2009 (Washington, DC) — The odds that a child living in a Lyme-endemic area of the United States who presents with a joint effusion will be diagnosed as having Lyme arthritis is 29%. The odds are even higher (44%) if the affected joint is the knee. The leukocyte count is useful in distinguishing between septic and Lyme arthritis, researchers announced here.

“There was an increase in the number of cases in the United States by 101% over the past 15 years, possibly due to increased recognition of Lyme disease,” said Aristides I. Cruz Jr., MD, resident in the Department of Orthopedics and Rehabilitation at Yale University in New Haven, Connecticut. During his presentation, he noted that 93% of all Lyme disease cases arise from 10 states, most in the Northeast United States.

“Children are more likely to present with arthritis as initial manifestation of Lyme disease,” Dr. Cruz told the audience.

“Children with Lyme arthritis presenting with a limp and a swollen joint will typically have a lower peripheral white blood cell count,” Dr. Cruz added. “They are less likely to have complete non–weight-bearing on the affected limb, less likely to have a fever, and [arthritis symptoms are] more likely to involve the knee joint compared with children with septic arthritis.”

The findings were reported here at the American Academy of Pediatrics 2009 National Conference & Exhibition.

Basic Diagnostic Tools Help Distinguish Lyme From Septic Arthritis

“In the Northeast, we see a lot of Lyme disease,” said Yi-Meng Yen, MD, PhD, instructor in orthopaedic surgery, Harvard Medical School, Children’s Hospital Boston in Massachusetts. “It is hard to distinguish whether [it] is Lyme disease or whether [it] is septic arthritis,” Dr. Yen agreed.

“Septic arthritis mandates that we take the patient to the operating room and do a surgery, whereas Lyme arthritis theoretically can be treated with antibiotics,” he told Medscape Pediatrics in an interview. For instance, he said, “Our institution has been looking at MRIs [magnetic resonance images] as a way to reliably distinguish between the two, because it takes several days sometimes for the lab tests to come back to definitely tell you whether you have Lyme disease or not. So, in those few days, if you have septic arthritis, that’s a bad thing.”

“To reliably, quickly diagnose what the patient has can help us determine the treatment quickly,” added Dr. Yen, who was not involved in this study.

“If you are clinically susceptible for septic arthritis, it pays to go to the operating room,” Dr. Cruz said in answer to a question from the audience. “In the past, almost all these patients automatically went to the operating room.”

However, if the clinical presentation is consistent with Lyme arthritis, treatment with antibiotics should suffice, he added. “The point of this study was to come up with some clinically useful criteria to arm ourselves with more tools to diagnose the disease.”

Dr. Cruz and his team sought to evaluate clinical parameters that could eventually be used to differentiate Lyme arthritis from septic arthritis in children and help with diagnosis and subsequent treatment.

In this retrospective analysis, the investigators reviewed data from children who underwent lower-extremity joint aspiration at Yale University Medical Center, a tertiary care children’s hospital in a Lyme disease endemic area.

Between August 2002 and August 2008, more than 200 children underwent a total of 212 aspirations for a joint effusion. Cell count, culture, hematologic inflammatory markers, and subsequent surgical intervention were available for 170 of the 212 aspirates.

Dr. Cruz’s team compared findings from 50 children with serologically confirmed Lyme disease with data from 21 patients with culture-positive septic arthritis.

They found statistically significant differences between the 2 cohorts. For instance, the peripheral white blood cell count was 9.5 x 1000/μL (range, 3.0 – 14.9 x 1000/μL) in the aspirates from children with Lyme disease vs 12.5 (range, 5.5 – 30.1) in children with septic arthritis (P = .002).

Other parameters, such as joint fluid cell count, erythrocyte sedimentation rate, and C-reactive protein levels, were not significantly different between the 2 groups and could not be used to differentiate between septic and Lyme arthritis.

Interestingly, said Dr. Cruz, of all the children presenting with a joint effusion at their hospital, 29% were likely to be diagnosed as having Lyme arthritis overall compared with 44% if the aspirate was a knee aspirate.

“Is it worthwhile to develop something that’s very reliable? Absolutely!” said Dr. Yen. “Especially in the Northeast centers. It is a growing healthcare problem and a lot more study should be put into it.”

Dr. Cruz and Dr. Yen have disclosed no relevant financial relationships.

American Academy of Pediatrics (AAP) 2009 National Conference & Exhibition (NCE): Abstract 5806. Presented October 17, 2009.

Authors and Disclosures
Journalist
Crina Frincu-Mallos, PhD
Crina Frincu-Mallos is a freelance writer for Medscape Medical News.

From  http://www.medscape.com/news